Reading the articles in this issue of Health Care for Women International, I want readers to consider that interconnected biosocial factors are both antecedent and consequential to health issues. Most research of these factors is at best correlational, so it is difficult or impossible to discern whether the factors cause health issues or result from them. This is especially the case when we consider factors such as “stress” which can predict why we do and do not seek interactions with health care providers. Stress, of course, is both antecedent and consequential to illness, pain or simply to feeling bad, and feeling bad changes our social relationships, including those with health practitioners.
Our authors are all highlighting biopsychosocial factors.
In San Francisco, JiWon Choi and Yoshimi Fukuoka studied both physical activity level and kinds of spousal support as they relate to spouses. They wanted to know if spouses were helpful in encouraging inactive pregnant women to increase their physical activity levels. We learn from this study that an active spouse is more effective than a verbally supportive spouse.
Yeong Jun Ju and colleagues present their research on the relationships between stress and depressive symptoms. When stress appears in more than one set of relationships among Korean women, such as stress associated with balancing family and work responsibilities, women's depressive symptoms increase.
Ela Koren and colleagues studied relationships of Israeli female veterans and the stress that occurs in association with both physical and mental disabilities. Disabled veterans had poorer mental health and lesser life purpose, but greater mastery when compared to a control group without disability. Authors explain that a high sense of mastery involves a need for control which subsequently may result in greater stress if/when one is suddenly disabled and loses situational control.
Georgia Rush and RoseAnne Misajon, in their study of women in Australia diagnosed with endometriosis, focused on the biopsychosocial consequences of endometriosis. Particularly for young women, the condition affects social relationships in all walks of life, seeming to make sustaining all relationships difficult.
I found two studies of immigrant women to be thought provoking. Although my personal stressors differ from those of the non-western immigrant women in Norway who participated in Siri Nyen and Bodil Tveit's study of how women explain chronic pain, like the women in this study, I have experienced a disconnect between what I expect from health providers and how the providers respond to me when I am in pain. The authors of this phenomenological study conclude needs of immigrant women are not met citing the disconnect as an example. I think such disconnections may be system driven and not confined only to immigrants. The authors seem to describe Norwegian practitioners as more holistic than their immigrant patients. I wonder about that since the study is phenomenological and the informants were immigrants rather than practitioners. While the study participants are described as recognizing the link between psychosocial stress, physical illness, and pain, immigrants report they expected primarily biomedical help from health providers. Maybe that is what the Norwegian system primarily provides. I don't know enough about the Norwegian health care system, but in the United States most of us recognize pain has interconnected biopsychosocial antecedents and consequences. My experience has taught me, unfortunately, that I must compartmentalize my presentation of symptoms to practitioners to get what I need from them. Thus, a practitioner licensed to prescribe pharmaceuticals for pain relief hears primarily my biomedical complaints, while to a mental health provider I present complaints linked to stress so I can receive mental health counseling, but my specific complaints about where my pain is currently located, I present to a physical therapist so she will design and I will receive help with an exercise program to extend my range of motion and build strength in the areas affected. I do what I do because I think my interactions with practitioners are most efficient when I behave as I do. I suspect, however, it would be difficult to explain my calculations to western or non-western immigrants, because they have limited experience with our system of primary, secondary, and tertiary care for chronic pain, a system in which counselors are not licensed to prescribe pharmaceuticals.
Frank Dillon and colleagues studied health care usage among first year Latina immigrants to south Florida in the United States, noting that the 36% who used the formal health care system were those who were most integrated in their new communities. I wasn't surprised to learn that having a job and having health insurance were related to usage as these factors also would provide some access to how our health system favoring biomedical interventions works.
As always, read to learn, and send comments when you are inspired.